The Relationship Between ST-Segment Depression in Lead aVR and Coronary Microvascular Function in Acute Inferior Myocardial Infarction

Aim: The aim of this study was to investigate the relationship between ST-segment depression in the aVR lead and coronary microvascular function in acute inferior myocardial infarction undergoing primary percutaneous intervention. Methods:  287 patients with inferior myocardial infarction confirmed by coronary angiography were divided into two groups with and without ST-segment depression in lead aVR  ≥ 0.1 mV on the 12 lead ECG. Electrocardiographic recordings were made for the evaluation of ST-segment resolution before and after primary PCI. Angiographic assessment in the infarct-related artery was performed by using the myocardial blush grade and thrombolysis in myocardial infarction flow.   Results: Overall, 51 of 287 patients had ST-segment depression in lead aVR. The number of patients with RCA-induced infarction was higher in the group with ST-segment depression in lead aVR. RCA involvement was present in 44 patients. Peak troponin was higher in the group with ST-segment depression in lead aVR compare to the other group (P <0.001). The MBG was more impaired, and the STR was less regressed in patients with ST depression in lead aVR  (p<0,001). The ejection fraction of patients with ST-segment depression in lead aVR was lower. Conclusion: We found that ST-segment depression in lead aVR was associated with impaired myocardial perfusion in patients with inferior myocardial infarction.